Transcript Reward and impulsivity

한국중독정신의학회 20주년 추계 심포지엄
Reward sensitivity and
Reward and impulsivity
impulsivity
2016. 11. 18.
백범기념관
건국대학교 의전원 및 중주병원
정신건강의학과 교수 서정석
Contents
impulsive
Reward sensitive
Reward seeking↑
addiction
뇌 보상 회로
and reward sensitivity
Haber and Knutson , Neuropsychopharmacology. 2010;35(1):4–26
베르나르 베르베르의 “뇌” 중에서
Addiction = conditioned reaction to reward(incentive) stimuli
ADDICTION DISORDER AND
IMPULSIVITY
Contents
Impulsive
Reward sensitive
Reward seeking
addiction
IMPULSIVITY AND S. MISUSE
Impulsivity
•
a construct with relevance to PG and multiple other psychiatric conditions
(Chambers et al, 2003; Pagani et al, 2009)
– the most ubiquitous personality traits found in the fields of psychology and
psychiatry
•
Multifactorial trait characterized by unplanned responding and hasty
decision making that may be unduly risky or neglect negative
consequences
(Brewer and Potenza, 2008; Moeller et al., 2004)
– a disturbance in reward motivation
(Zuckerman , 1993)
and identified through risk-taking
(Evenden , 1999)
– a deficit in inhibitory control
•
(Schachar & Logan, 1990; Schachar & Wachsmuth, 1991)
an inability to delay gratification because of the aversive nature of waiting
in children
(Sonuga-Barke & Taylor, 1992; Sonuga-Barke et al., 1992)
As a component in personality
• major model of personality
– Five-Factor Model
– Eysenck’s P–E–N
(Costa & McCrae, 1992; Goldberg, 1993)
– Tellegen’s three-factor model
– DSM-IV and ICD-10
Whiteside and Lynam, Personality and Individual Differences, 2001;30: 669–689
Scale for impulsivity
•
Personality tests and reports
–
Barratt Impulsiveness Scale
–
Eysenck Impulsiveness Scale
–
Dickman Impulsivity Inventory
–
UPPS Impulsive Behavior Scale
–
Lifetime History of Impulsive Behaviors
–
Behavioral Inhibition System/Behavioral
•
Behavioral paradigms
–
Marshmallow test
–
Delay discounting
–
Go/no-go and Stop-signal reaction time
tasks
–
Balloon Analogue Risk Task
–
Iowa Gambling Task
–
Differential Reinforcement of Low Response
Activation System
–
Impulsive/Premeditated Aggression Scale
–
Padua Inventory
Rate Task
–
Other
•
Continuous performance task
•
5-choice serial reaction time task
•
Stroop task
•
Matching Familiar Figures Task.
Activity 5
충동성이 무엇인지 한번 해봅시다.
재미있는 두뇌 검사
색깔을 말씀해주세요.
글자를 말씀해주세요.
다리
모자
사진
기차
색깔을 말씀해주세요.
파랑
꽁초
녹색
담배
노랑
소주
빨강
이런 검사를 통해 충동성 이 증가되었다면?
담배 등에 의해 뇌가 과부하가 걸렸거나
조절력에 문제가 생겼다는 것을 의미합니다.
Isolation of Specific Interference Processing
in the Stroop Task: PET Activation Studies
anterior cingulate cortex (ACC)
dorsolateral prefrontal cortex
(DLPFC)
More specifically, while both are
activated when resolving conflicts
and catching errors, the DLPFC
assists in memory and other
executive functions, while the ACC
is used to select an appropriate
response and allocate attentional
resources
Stroop JR (1935). "Studies of interference in serial verbal reactions". Journal of Experimental Psychology. 18 (6): 643–662
Taylor S et al (1997). "Isolation Of Specific Interference Processing In The Stroop Task: PET Activation Studies.". NeuroImage
impulsivity models
• 1 factor
1)
: Reward Sensitivity
• 2 factor : RS + rash impulsiveness
• 3:
(Dawe & Loxton, 2004)
Behavioral inhibition, behavioral activation, affective responses (Carver & White, 1994):
• 4 UPPS impulsive behaviour scale
(Whiteside & Lynam, 2001):
– Based on 5 factor: openness to experience, conscientiousness, extraversion,
agreeableness, and neuroticism
(Costa & McCrae, 1992)
– UPPS scales accounted for between 7% (pathological gambling) and 64%
(borderline personality disorder features
• 5 UPPS+P
(Whiteside & Lynam, 2001):
(Cyders et al., 2007)
1) Dissabandara et al., 2014; Franken & Muris, 2006; Gullo & Dawe, 2008; Kabbani & Kambouropoulos, 2013; Kambouropoulos & Staiger, 2004;
Knyazev, Slobodskaya, Kharchenko, & Wilson, 2004; Loxton & Dawe, 2001; Lyvers, Czerczyk, Follent, & Lodge, 2009; Lyvers, Duff, & Hasking, 2011;
O'Connor & Colder, 2005; Pardo, Aguilar, Molinuevo, & Torrubia, 2007; Smerdon & Francis, 2011)
Two factor model of impulsivity
① reward sensitivity: the sensitivity to signals of reward
② rash impulsiveness
• Impulsivity
– the tendency to engage in behavior that involves rashness, a lack of foresight or
planning, or as a behavior that occurs without reflection or careful deliberation.
– novelty seeking, behavioral undercontrol and disinhibition
– clear relationship between impulsivity and substance use has been consistently
found
Dawe et al, Addictive Behaviors 29 (2004) 1389–1405
Gray’s theory in
which two interacting systems
↑
Related structures
Behavioral
Inhibition System
(BIS)
more likely to inhibit
approach behavior that is
accompanied by subjective
feelings of anxiety/
frustration
septo-hippocampal system,
comprising the
hippocampus
proper, dentate gyrus,
entorhinal cortex, subicular
area (subiculum) and the
posterior cingulate cortex.
Behavioral
Approach System
(BAS).
more likely to engage in
approach and active
avoidance behavior and to
experience greater positive
affect in situations
containing cues for reward
mesolimbic dopaminergic
pathways
Gray, 1970, 1975, 1987a, 1987b; Gray & McNaughton, 2000
two core processes
1) impulse, to approach drugs
2) a reduced capacity to inhibit this approach behavior
Gullo et al. Addictive Behaviors 39 (2014) 1547–1556
Recent evidences with 2 factors
•
Quinn and Harden (2013) found changes in (“Rash”) Impulsivity predicted alcohol,
marijuana and cigarette use in adolescence/young adulthood, whereas Sensation
Seeking was predictive of alcohol use only.
•
Using a large, longitudinal dataset, Handley et al. (2011) found (Rash) Impulsivity
to uniquely predict externalizing problems (ADHD and conduct disorder), while
Sensation Seeking uniquely predicted substance use.
•
Castellanos-Ryan, Rubia, and Conrod (2011) similarly found Sensation Seeking and
a reward response bias were uniquely associated with binge-drinking in
adolescents, whereas (Rash) Impulsivity and deficits in response inhibition were
associated with conduct disorder.
Gullo et al. Addictive Behaviors 39 (2014) 1547–1556
The neurobiology of impulsivity
and substance misuse
Long-term exposure to drugs has been found to cause permanent
changes to these pathways, which in turn later affect a range of brain
functions including the reinforcement value of drug-related cues, hedonic
drug effects, incentive motivation, drug cravings, and executive functioning
(e.g., Jentsch & Taylor, 1999; Kelley & Berridge, 2002; Koob & Le Moal, 1997; Robinson & Berridge, 2003).
1. Incentive salience
and the dopaminergic
pathways
the salience of the rewarding
and/or reinforcing quality of the
substance following an initial
period of use.
• wanting and liking
2. Disinhibition and
impaired functioning in
the prefrontal cortex
(OFC)
damage to the
prefrontal cortex has been
implicated in the inability to
inhibit impulsive behavior
• impulsive behavior
• impaired extinction
of learned
associations
3. Prefontal dysfunction
and the implications for
substance misuse risk
dopamine-related reinforcement
of drug effects as underpinning
initial drug involvement which,
with continued use
• compulsive drug
intake
• loss of control
Dawe et al, Addictive Behaviors 29 (2004) 1389–1405
Impulsivity, whether measured by self-report,
observer-report, or behavioral performance, is
a robust predictor of current and future
problems with substance use
Dawe & Loxton, 2004; Jentsch & Taylor, 1999; Moeller et al., 2001; Moffitt et al., 2011; Nigg
et al., 2006; Potenza, 2013; Tarter et al., 2003
4 or 5 factor model of impulsivity
4 factors
5 factors
U
Urgency
from Negative mood: (-) urgency
P
(lack of) Premeditation
P
(lack of) Perseverance,
S
Sensation seeking
+P
impulsive behavior arising from positive
mood states: (+) urgency
• UPPS Impulsive Behavior Scale: a 45-item self-report questionnaire
• UPPS+P Impulsive Behavior Scale (UPPS+P)
• a revised version of the UPPS, including 59 items.
• UPPS+P short version (UPPS+Ps)
• 20-item scale for five facets (4 items per dimension)..
Cyders et al, Psychological Assessment, 2007;19:107–118.
Gullo et al. Addictive Behaviors 39 (2014) 1547–1556
UPPS+P를 이용한 종적, 단면 연구 결과 정리
• only (Lack of) Premeditation and Negative
Urgency are consistently associated with
substance use.
– The (Lack of) Premeditation trait is most similar
to the (Rash) Impulsivity/Disinhibition traits
typically found in substance use studies.
Gullo et al. Addictive Behaviors 39 (2014) 1547–1556
OTHER STUDIES
Impulsivity predicts problem gambling
in low SES adolescent males
•
가설: 13-14세(n=333)의 충동성이 17세(n=168)의 도박 성향을 예측할 수 있다.
•
Impulsivity measures
•
–
teacher ratings
–
self-reports
–
two laboratory tasks(delay-of-gratification task and one card-playing task)
Gambling: South Oaks Gambling Screen for adolescents
Vitaro et al, Addiction (1999) 94(4), 565± 575
Similarities and differences among Internet gaming
disorder, gambling disorder and alcohol use disorder: A
focus on impulsivity and compulsivity
• IGD group showed a decreased proportion of successful stops on
the stop-signal test compared with the HC group.
• IGD group scored significantly higher BIS-11 scale.
Choi et al, Journal of Behavioral Addictions 3(4), pp. 246–253 (2014)
The Effect of Behavior Inhibition System on
Smart-Phone Addiction : The Mediation Roll of
Depression
• BIS와 우울, 스마트폰 중독은 유의한 정적 상관
• BIS는 우울을 유의하게 설명하였으며, 스마트폰 중독도 유의하게 설명
• BIS가 신경증적 경향성/우울장애와 관련이 있다는 연구 결과와 일치
Jung et al, J Korean Neuropsychiatr Assoc 2016;55(2):97-102
기타 연구 결과
• The children of parents with substance use disorders
constitute an alternative high-risk group, and also display
markers of both impulsive action
choice
(Acheson, et al. 2011a)
and impulsive
(Acheson, et al. 2011b)
• the small number of existing studies also point to trait
impulsivity and poor self-control from as early as 3 years of
age, predicting later development of gambling problems, as
well as alcohol, nicotine, and marijuana misuse
tal, 2005; Slutske et al, 2012)
(Vitaro et al, 1999; Slutske e
Summary: impulsivity is a core
vulnerability to addictive
behavior.
Reward sensitivity and disinhibition
play an important and unique role in
addictive behavior.
IMPULSIVITY IN ADDICTION
Contents
Impulsive
Reward sensitive
Loss of control
addiction
1. Gambling and PG
Compared to non-PG
(or problem gambler),
relatively diminished
activation of
1. the PFC (particularly
VM, VL, OFC)
2. subcortical regions
(particularly the
ventral striatum)
Diminished Frontostriatal activity during
processing of monetary rewards and losses in PG
14 PG vs 14 control
Monetary Incentive Delay Task
Barratt Impulsiveness Scale.
Brain activation changes of
1) reward/loss prospect
2) reward/loss anticipation
3) reward/loss notification
significantly reduced activity
in the VM PFC, insula, and
ventral striatum during
several phases, including
the prospect and
anticipation phases of both
gains and losses
impulsive tendencies in addictions may
be reflected in diminished these area
Balodis et al, BIOL PSYCHIATRY 2012;71:749–757
2. abnormal brain structure implicated in
stimulant drug addiction
Reduced FA in fiber tracts adjacent to the right IFG was
significantly associated with poorer inhibitory control and
accounted for ~6% of the variance in SSRT (Fig. 1C).
- > indicating poor self control in stimulant addictors
Stop signal reaction time (SSRT)
Ersche et al, SCIENCE VOL 2012;335:601-604
3. Internet gaming
배외측 전두엽: 목적 지향적 활동을 기획하는 곳
- 작업 기억 – 온라인 게임에 몰두하게 한다.
- 이전의 긍정적 경험(보상, 강화물)을 떠올리며 게임 하기를 결정
내측 전두 피질: 게임하기, 갈망
우측 안와 전두피질: 결과를 예측하면서 적절한 동기에 부합되는 목적 지향적 행동을
관장 한다. (Rolls, 2000).
Preoccupation & craving
앞쪽 대상피질:
게임 욕구과 갈망, 특히 게임 관련 단서를 주었을 때 갈망하기와 관련이 있으며,
보상을 갈구하는 행동을 조절하는 역할을 한다.(Chiamulera, 2005; Risinger et al., 2005).
보상회로
측좌핵: 동기 증진
선조체: 습관 형성
Liking
wanting
Ko et al, Journal of Psychiatric Research 2009:739–747
The neurobiology of impulsivity
and substance misuse
Long-term exposure to drugs has been found to cause permanent
changes to these pathways, which in turn later affect a range of brain
functions including the reinforcement value of drug-related cues, hedonic
drug effects, incentive motivation, drug cravings, and executive functioning
(e.g., Jentsch & Taylor, 1999; Kelley & Berridge, 2002; Koob & Le Moal, 1997; Robinson & Berridge, 2003).
1. Incentive salience
and the dopaminergic
pathways
the salience of the rewarding
and/or reinforcing quality of
the substance following an
initial period of use.
• wanting and liking
2. Disinhibition and
impaired functioning in
the prefrontal cortex
(OFC)
damage to the
prefrontal cortex has been
implicated in the inability to
inhibit impulsive behavior
• impulsive behavior
• impaired
exticntion of
learned associations
3. Prefontal dysfunction
and the implications
for substance misuse
risk
dopamine-related reinforcement
of drug effects as underpinning
initial drug involvement which,
with continued use
• compulsive drug
intake
• loss of control
Conclusion: trait and statedependent
Impulsive
Reward sensitive
Loss of control
Reward seeking
addiction